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Neurosurgery. 2003 Feb;52(2):357-62; discussion 362-3.
Familial aggregation of intracranial aneurysms in an Inuit patient population in Kalaallit Nunaat (Greenland).
Lindgaard L, Eskesen V, Gjerris F, Olsen NV.
University Clinic of Neuroanaesthesia, The Neuroscience Center, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
OBJECTIVE: The incidence of subarachnoid hemorrhage (SAH) and intracranial aneurysm (IA) has been reported to be higher in Greenlandic Inuits than in Caucasian Danes, but the rate of familial aggregation in Inuits is unknown. METHODS: This study retrospectively compared the rate of familial aggregation of SAH and IA (at least one first- or second-degree relative with presumed SAH and/or IA) in 120 Inuit patients from Greenland admitted to the Copenhagen University Hospital in Copenhagen, Denmark, from 1978 to 1998 with a diagnosis of ruptured IA with that in 1,037 Caucasian Danes admitted from 1978 to 1983. RESULTS: Inuit patients had a much higher rate of familial history of SAH (23.1%) and of IA (9.6%) than Danish patients (4.3 and 1.6%, respectively). In both populations, familial SAH was associated with lower age at the time of aneurysm rupture. Danish patients with familial SAH showed a higher rate of middle cerebral artery aneurysms (40 versus 26% in sporadic SAH). In Inuit patients with familial and nonfamilial SAH, 42 and 38% of the aneurysms originated from the middle cerebral artery. The overall rate of multiple aneurysms was highest among Inuits, and in both populations, it was increased in the presence of a positive family history. CONCLUSION: The rate of a positive family history of presumed SAH and IA is high among Inuits who present with SAH compared with Caucasian Danes who present with SAH. This finding, coupled with a higher rate of multiple aneurysms and younger age at presentation, suggests a potential genetic influence among Inuit families.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12535364&dopt=Abstract hemorrhage
J Vasc Interv Radiol. 2002 Dec;13(12):1269-74.
Snare retrieval of intracranial thrombus in patients with acute stroke.
Kerber CW, Barr JD, Berger RM, Chopko BW.
Department of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive, San Diego, California 92103, USA. cwkerbecsd.edu
Intravenous or intraarterial thrombolysis of intracranial emboli is becoming an accepted clinical treatment modality for acute ischemic stroke, but not all emboli respond to the lytic drug regimens available today. If drug therapy fails, mechanical retrieval seems warranted. Four patients whose condition was resistant to intravenous and intraarterial thrombolytic drug treatment underwent at least partial clot removal with use of a snare, and almost immediate clinical improvement was noted. A fifth patient's clot was removed before lytic drugs were administered. All five patients, who presented with a sudden onset of stroke, were evaluated by arterial angiography; then, after a failed trial of intraarterial fibrinolytic drugs, they were treated by passing a 2- or 4-mm snare through a microcatheter. The snare wire was guided around the thrombus, gently brought back toward the microcatheter-but not into it-and the entire microcatheter and snare assembly was then removed. In four of the five cases, follow-up angiography performed immediately after the retrieval showed wider distal branches than normal. Follow-up computed tomography results were abnormal in all cases, showing hyperdense material in the territory that was previously ischemic. This hyperdensity subsided within 48 hours in all but one patient who developed small parenchymal hemorrhages; however, he remained asymptomatic. The snare device offers an additional or alternative therapy until completely effective thrombolytic agents become available. Although use of a snare is not ideal, device improvements should make the retrieval less technically challenging and more effective. There is a need for improved mechanical extraction devices, especially in light of the patient improvement that occurred. This experience also suggests that immediate removal of a mature clot could reduce the total time of brain ischemia more quickly than administration of thrombolytic drugs.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12471193&dopt=Abstract hemorrhage
J Fr Ophtalmol. 2002 Oct;25(8):813-6.
[Bilateral peripheral retinal neovascularization in a patient with multiple sclerosis]
[Article in French]
Katsimpris JM, Petropoulos JK, Pharmakakis NM.
Clinique d'Ophtalmologie, Hopital General de Patras Agios Andreas , Grece. jkatsimpriahoo.com
We present the case of a 32-year-old man suffering from multiple sclerosis who had developed bilateral peripheral neovascularization of the retina. The main disease had been diagnosed 10 years before, whereas in his ophthalmic history the patient reported an incident of retrobulbar optic neuritis in his left eye occurring 3 years before. The patient was referred to our clinic in order to investigate the cause of a sudden loss of vision in his left eye. Ophthalmic examination and fluorescein angiography revealed the presence of a bilateral peripheral retinal neovascularization with an intravitreous hemorrhage in the left eye. Systemic clinical and laboratory investigation were negative for other causes of retinal neovascularization except multiple sclerosis, which is associated with periphlebitis in 10% of cases. Chronic retinal ischemia may lead to retinal neovascularization.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12471348&dopt=Abstract hemorrhage
Acta Neuropathol (Berl). 2003 Jan;105(1):14-7. Epub 2002 Oct 22.
Incidence of cerebrovascular lesions in Alzheimer's disease: a postmortem study.
Jellinger KA, Attems J.
Institute of Clinical Neurobiology, 18 Kenyongasse, 1070 Vienna, Austria. kurt.jellingenivie.ac.at
Recent epidemiological and clinico-pathological data suggest overlaps between Alzheimer's disease (AD) and cerebrovascular lesions (CVL) that may show some synergistic effects, but the results of studies of the relationship between AD and stroke have been controversial. The objective of this study was to compare the frequency of cerebral infarcts, hemorrhages and minor cerebrovascular lesions in autopsy-confirmed AD and age-matched control brains. Using current routine and immunohistochemical methods 173 consecutive cases of autopsy-confirmed AD and 130 age-matched controls were compared. The total incidence of vascular pathology (56.5%) in AD was significantly less than in a previously reported smaller AD autopsy cohort (82.3%) (P<0.01), and was higher than in controls (42.4%). The incidence of severe CVL (old and recent infarcts, hemorrhages) in our cohort was slightly higher (12.7%) than in controls (8.5%), that of minor to moderate CVL (lacunes, cerebral amyloid angiopathy with or without minor vascular lesions) was more frequent in AD (43.8%) than in controls (33.9%), but the results were not statistically significant (P<0.03). The brain weight and severity of cognitive decline did not correspond to the degree of vascular pathology, but higher neuritic Braak scores and reduced brain weight contributed to the production of cognitive impairment. Like previous findings in Parkinson's disease, our data do not indicate a protective effect from stroke or a significantly greater susceptibility to death from stroke in AD in the population studied, but further prospective clinico-pathological studies are necessary.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12471455&dopt=Abstract hemorrhage
Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2002 Dec;174(12):1511-5.
[Lumbar meningeal enhancement after surgery in the posterior cranial fossa: a normal finding in children?]
[Article in German]
Krampla W, Schatzer R, Urban M, Newrkla S, Knosp E, Hruby W.
Institut fur Rontgendiagnostik, Donauspital Wien und LBI fur digitale Radiographie und interventionelle Radiologie, Germany.
PURPOSE: Spinal meningeal Gd-DTPA enhancement after cranial surgery is a known observation of a not well understood underlying mechanism. This paper demonstrates that this MRI finding is a normal meningeal reaction to subarachnoid hemorrhage, which should not be mistaken for metastatic spread. MATERIAL AND METHODS: Three pediatric patients were examined by MRI for metastatic spread of malignant infratentorial tumors along the spinal canal two to nine days after the removal of the primary cerebral lesion. The findings were compared with a control group that underwent cranial surgery (cyst resection or fenestration of the posterior cranial fossa) without major bleeding into the subarachnoid space. Unenhanced and enhanced sequences were obtained to prove that the high signal within the CSF is caused by an abnormal Gd-DTPA uptake and not by methemoglobin. RESULTS: Meningeal enhancement was observed in all patients with intraoperative bleeding resembling subarachnoid masses on enhanced T 1 -weighted images. This was not present in any patient of the control group. This finding lasts for approximately two weeks. CONCLUSION: The meningeal enhancement renders immediate postoperative studies inconclusive for the detection of metastatic spread. Consequently, the obligatory tumor staging along the spinal canal should ideally be done prior to the resection of a cerebral tumor.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12471522&dopt=Abstract hemorrhage
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